Students will be considered for Grade 8 only if they are transferring from another Catholic school.

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1 St. Benedict Catholic Church and School 165 Bethany Road Holmdel, New Jersey Phone: Fax: Dear Parents/Guardians, Welcome to St. Benedict School! We are very proud of our school faculty, staff, students, academic program, extracurricular activities, and, of course, the strong values that are part and parcel of who we are. For those of you with other children in our school, we are happy that you will be continuing your connection to SBS. For those of you who are new to the school, we are pleased that your family is interested in becoming part of our school community. Please complete the forms listed below and return them to the school office: 1. Registration Form: school if the student is in Grades Chapter 79 Individual Request for Loan of Textbooks: Fill in name/address of student and sign. 3. Bus Transportation Form(s): Fill out form(s) completely even if you will not choose to use the bus. In addition to those forms, we require the following of all applicants: Application/Registration Fee (per family) of $250 (non-refundable if the student is accepted) original birth certificate (we will make a copy) For students entering Grades 1-8 we also require the following: Academic records (report card and standardized test scores) Behavioral records Personal interview Pre-admission information release form Students will be considered for Grade 8 only if they are transferring from another Catholic school. Please note that we do not consider applications to St. Benedict School on a first-come, first-served basis. Rather, we evaluate applications on an individual basis, with the principal making the final decision. You must complete registation packet. Again, thank you for your interest in St. Benedict School. Sincerely yours, (Ms.) Mary Ellen Lilly Principal

2 St. Benedict, Holmdel, NJ Registration 2016/2017 Last Name First Middle Sex: M F New G rade,,,, Address City Z IP Code Telephone Public School District of Residence Month day year / / Place of birth (city, state) Date of Birth Country of Citizenship Father's E mail Address Religion Registered Parish City/Town Length of Time in Parish Envelope # Present School Attending: G rade: School Address: School Phone: Reason for Leaving: Other Schools Attended: G rade: School Address: School Phone: Reason for Leaving: Parish City & State Date Baptism First Penance First Eucharist Confirmation Has child or other family member ever attended St. Benedict School? If yes, when FOR OFFICE USE ONLY Reason for Leaving: ( ) Birth Certificate ( ) Nurse Name of Student: ( ) Baptismal Certificate ( ) Secretary ( ) Immunization Record ( ) Finance Has your child ever been evaluated by a Child Study Team? ( ) Report Card/Stand. Test If yes, date Classification? ( ) Standardized Test Scores Other Pertinent Information: ( ) Tax Bill/Utility Bill ( ) Registration Fee Check # ( ) Accepted Y/N

3 F A M I L Y B A C K G R O UND (Please supply all requested information) Name Address (If different from child) Occupation/Employer Work Address/Phone E-M ail Address Date of Death Education Father Elementary Secondary College Advanced Mother Elementary (include Secondary maiden College name Advanced Guardian Elementary Secondary College Advanced Religion Relationship of guardian to student Home situation (Check all that apply): Two Parents One Parent Parents separated or divorced Restructured mother/stepfather Father remarried Mother remarried Restructured-stepmother/father Other Child resides with Parental rights in case of separation or divorce (attach copy of court order) Language spoken at home SIB L IN GS Complete Name Date of Birth Grade School Attending

4 INDIVIDUAL PUPIL REQUEST FOR LOAN OF TEXTBOOKS 2016/2017 School Year Date: Public School District: Address: Holmdel Township 4 Crawfords Corner Road Holmdel, NJ Nonpublic School: Address: St. Benedict School 165 Bethany Road Holmdel, NJ Name of Pupil: Grade: Name of Parent: Under the provisions of N.J.S.A. 18a: ET SEQ., I HEREBY REQUEST THE Holmdel Public School District to loan textbooks to St. Benedict School in which my child is enrolled. I certify that my above named child and I are residents of the State of New Jersey. I understand that the board of education of the public school district in which the nonpublic school is located with state funding is responsible for providing the loan of textbooks to non-public school pupils pursuant to law and regulations. Signature of Parent/Guardian: Date:

5 NEW JERSEY STATE DEPARTMENT OF EDUCATION OFFICE OF STUDENT TRANSPORTATION (B6T) APPLICATION FOR PRIVATE SCHOOL TRANSPORTATION Please submit a separate application for each child to the private school SCHOOL YEAR RESIDENT DISTRICT BOARD OF EDUCATION STUDENT's NAME DATE OF BIRTH LAST FIRST MIDDLE MONTH DAY YEAR GENDER PARENT/GUARDIAN NAME DAYTIME PHONE M or F AREA CODE + NUMBER HOME ADDRESS NEAREST INTERSECTION TO STUDENT'S RESIDENCE MAILING ADDRESS CITY or TWP ZIP ZIP FULL NAME OF SCHOOL TO BE ATTENDED St. Benedict School PHONE ADDRESS OF SCHOOL 165 Bethany Road, Holmdel, N.J STUDENT'S GRADE FOR THE COMING YEAR DATE SCHOOL OPENS 09/2016 SHORTEST ONE-WAY MILEAGE BETWEEN HOME AND SCHOOL MILES TENTHS (MEASURED VIA THE SHORTEST ROUTE ALONG PUBLIC ROADWAYS OR WALKWAYS IN MILES AND TENTHS) CLOSES 06/2017 SCHOOL HOURS FROM 8:00 AM TO 2:15 PM NAME AND ADDRESS OF LAST SCHOOL OF ATTENDANCE DATE SIGNATURE DO NOT WRITE BELOW THIS LINE * FOR PUBLIC SCHOOL USE ONLY YOUR APPLICATION HAS BEEN REVIEWED BY THE RESIDENT DISTRICT BOARD OF EDUCATION. THE FOLLOWING DETERMINATION HAS BEEN MADE: TRANSPORTATION WILL BE PROVIDED YOU ARE ELIGIBLE FOR PAYMENT IN LIEU OF TRANSPORTATION INELIGIBLE (REASON) DATE SIGNATURE TITLE INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR PRIVATE SCHOOL TRANSPORTATION (B6T) N.J.A.C. 6A: IT IS THE OBLIGATION OF THE PARENT OR GUARDIAN OF PRIVATE SCHOOL STUDENTS TO: ANNUALLY OBTAIN THE APPLICATION FOR PRIVATE SCHOOL TRANSPORTATION FROM THE ADMINISTRATIVE OFFICE OF THE PRIVATE SCHOOL FOR EACH STUDENT FOR WHICH TRANSPORTATION SERVICES ARE BEING REQUESTED. SUBMIT A SEPARATE APPLICATION FOR EACH STUDENT. N O T E: o IF THERE IS A CHANGE OF HOME ADDRESS, A NEW APPLICATION SHALL BE SUBMITTED TO THE PUBLIC SCHOOL DISTRICT OF RESIDENCE. o IF THERE IS A CHANGE IN THE NONPUBLIC SCHOOL OF ATTENDANCE, A NEW APPLICATION SHALL BE SUBMITTED TO THE PUBLIC SCHOOL DISTRICT OF RESIDENCE. COMPLETE THIS APPLICATION AND RETURN IT TO THE PRIVATE SCHOOL ON OR BEFORE MARCH 10 TH PRECEDING THE SCHOOL YEAR IN WHICH TRANSPORTATION IS BEING REQUESTED. LATE APPLICATIONS ANY APPLICATION RECEIVED AFTER MARCH 10 TH WILL BE A LATE APPLICATION AND MUST BE ACCOMPANIED BY A STATEMENT OF THE REASON FOR LATENESS. ELIGIBLE STUDENTS WILL RECEIVE TRANSPORTATION OR AID IN LIEU OF TRANSPORTATION BASED ON THE DATE THE APPLICATION IS RECEIVED BY THE PUBLIC SCHOOL. 2. IT IS THE OBLIGATION OF THE NONPUBLIC SCHOOL ADMINISTRATOR TO ANNUALLY COLLECT THE APPLICATION AND SUBMIT IT TO THE PUBLIC SCHOOL FROM WHICH TRANSPORTATION IS BEING REQUESTED PRIOR TO MARCH 15 TH. 3. IT IS THE OBLIGATION OF THE PUBLIC SCHOOL ADMINISTRATOR TO NOTIFY THE PARENT OR GUARDIAN AS TO THE DETERMINATION OF EACH APPLICATION BY AUGUST 1 ST. A DISTRICT BOARD OF EDUCATION SHALL PAY AID IN LIEU OF TRANSPORTATION TO THE PARENT OR GUARDIAN OF AN ELIGIBLE STUDENT ONLY AFTER RECEIVING A SIGNED FOR PAYMENT OF TRANSPORTATION VOUCHER AS PRESCRIBED BY THE COMMISSIONER OF EDUCATION. H:\My Documents\TRANSFER\Registration Forms\ \b6t Version 3/2014

6 St. Benedict Catholic Church and School 165 Bethany Road Holmdel, New Jersey Phone: Fax: Release to Obtain Pre-Admission Information for Student Applicant I, (printed name of parent/guardian), give permission to the principal, social worker, or relevant faculty member of St. Benedict School to communicate with school personnel at Please Print School Name regarding my child,, Please Print Name of Student as part of the St. Benedict School admission screening process. I understand that all information received will be held as confidential and cannot be released without written permission of the parent or legal guardian. I further understand that if it is established after my child is accepted into St. Benedict that I was not forthcoming about information requested in the pre-admission interview, I Signature Date Relationship to child